Basic Information
| Provider Information | |||||||||
| NPI: | 1679710354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | C. MEDRANO MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR | ||||||||
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| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153737600 | ||||||||
| FaxNumber: | 8663461426 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 FANNIN ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137971100 | ||||||||
| FaxNumber: | 7137979757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2009 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | KORDONOWY | ||||||||
| AuthorizedOfficialFirstName: | WADE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIVISION VP/AO | ||||||||
| AuthorizedOfficialTelephone: | 7132181762 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 204605001 | 05 | TX | MEDICAID |